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rJr? 10?LCJli 1.:1:14 2UJ4b4Ui yn CAL WATER, PAGE 02/03 <br /> pTza ��C7 6 <br /> FOR <br /> Date , <br /> i70B Er -- <br /> �a <br /> DepartAPNmeot of public lgox)m <br /> $ P3ic-asst Name) <br /> Typa <br /> AREA <br /> � + <br /> Mailing Lxoss) FOPM3 <br /> NOTE <br /> {C tyrpabat:a3, .zip code) <br /> (AV--a code - Tal.ephm=B member). ; <br /> 5ketcl7 (Detailedpias may be aisbttted) <br /> The uadersig ad hereby applies for permiasioa to.excavate, aoagtruat 'andjor <br /> atb.Pswlse-aaarmach mz Ca�mty- ghy* Right-a -ley a •t7se, ►�Lenk . sf <br /> appxa�cimately mile O <br /> �:y f ez€Dmnitg the <br /> fallowing work (description of,work) : <br /> -gork wr'.11 co=wxLce na or'about 1 for app=ximately <br /> lop <br /> T, the un&rsigued c.•esti,fy, that T am the owuez of•the respect i',rQ .pznpar1�y, Dxin <br /> atn <br /> qualified to represent the owner and' agree to do the mark. desGr3bed. above. <br /> aecarr]auee with the rules, regAatio= of San Joaqu= -6unty =d sub]ecrc to <br /> jxzpectiaa and approval. <br /> S3.gnat==a of Appliammt: Title Da'•t+� <br /> . t <br />